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Evaluating Predictors & Interventions in Sphincter of Oddi Dysfunction (EPISOD)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00688662
Recruitment Status : Completed
First Posted : June 3, 2008
Results First Posted : July 28, 2016
Last Update Posted : April 19, 2018
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Information provided by (Responsible Party):
Peter Cotton, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Brief Summary:
The Evaluating Predictors & Interventions in Sphincter of Oddi Dysfunction(SOD) study (EPISOD) is a randomized sham-controlled study of biliary and pancreatic sphincterotomy as treatment for patients with pain after cholecystectomy fitting the criteria for sphincter of Oddi dysfunction type III.

Condition or disease Intervention/treatment Phase
Sphincter of Oddi Dysfunction Procedure: ERCP with sphincterotomy Procedure: ERCP without sphincterotomy Not Applicable

Detailed Description:

Clinical Trial Phase: Phase III

Study Sites Seven clinical centers in US

Study Period Planned enrollment period - 3 years

Planned duration of the study - 5 years

Study Population SOD III Patients

Primary Study Objective: To ascertain whether subjects with SOD III respond to sphincterotomy,

Secondary Study Objectives

To evaluate:

  • the association between the results of Sphincter of Oddi Manometry (SOM) (abnormal/normal) and the primary outcome (success/failure);
  • the success rate (as defined in the primary) of subjects who receive biliary sphincterotomy alone versus subjects who receive both biliary and pancreatic sphincterotomy in the subgroup of patients with manometrically proven hypertension of the pancreatic sphincter;
  • the effects of pre-specified prognostic factors on the primary outcome;
  • anxiety and depression scores over time and their relation to study outcomes;
  • the economic impact of SOD III, and of endoscopic sphincterotomy in patients with SOD III; and, to,
  • conduct a careful follow-up study (EPISOD2) of standard of care treatment (separate protocol).

Study Design The EPISOD Trial is a parallel, randomized, double-blinded, sham-controlled, multicenter Phase III clinical trial of endoscopic sphincterotomy as treatment for adults 18 to 65 years of age diagnosed with SOD III.

Sample Size A minimum of 214 subjects will be randomized using a 2:1 allocation in favor of sphincterotomy and will be followed for 12 months post-randomization.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 214 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase III Randomized Multicenter Clinical Trial of Sphincterotomy for the Treatment of SOD III Patients
Study Start Date : July 2008
Actual Primary Completion Date : December 2013
Actual Study Completion Date : December 2016

Arm Intervention/treatment
Active Comparator: 1.ERCP with sphincterotomy
ERCP with sphincterotomy: cutting the biliary sphincter muscle (sphincterotomy)
Procedure: ERCP with sphincterotomy
cutting the biliary sphincter muscle (sphincterotomy)

Placebo Comparator: 2.ERCP without sphincterotomy
ERCP without cutting the biliary sphincter muscle (sphincterotomy)
Procedure: ERCP without sphincterotomy
ERCP with sphincter manometry, but no sphincterotomy

Primary Outcome Measures :
  1. Percentage of Participants With Success [ Time Frame: 1 year ]
    The primary outcome was a dichotomous (success/failure) variable. Success was defined as patients having a RAPID score of <6 days at months 9 and 12 post-procedure, without re-intervention and without use of prescription analgesics during months 10, 11 and 12 unless used for non-abdominal pain for no more than 14 days. The subject was considered a failure if the 12-month RAPID score was missing or collected outside the acceptable window. If the 9-month RAPID was missing, or outside of the window, then the 6-month value was used when available.

Secondary Outcome Measures :
  1. Percentage of Patients With a Successful Primary Outcome, Out of Those With Abnormal Sphincter Manometry. [ Time Frame: 1 year ]
    Successful outcome was defined using the primary outcome definition of success at 12 months post randomization. Abnormal sphincter manometry was determined as a basal pressure of more than 40mm Hg in both leads.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patients diagnosed with the clinical syndrome of SOD, as defined by the Modified Functional Biliary Disorders Module of the Rome III criteria
  2. Pain burden of Grade 3 or higher on RAPID Questionnaire.
  3. Cholecystectomy more than 90 days before enrollment.
  4. Laboratory Tests: Results of blood tests taken within 1 week preceding the baseline visit and any others available from the preceding 6 months (post-cholecystectomy):Direct bilirubin, alkaline phosphatase, amylase and lipase results must be no greater than 2 X the upper level of normal.Transaminase levels can be no more than 3 X upper limit of normal. If the transaminases are elevated (<2X ULN) in association with a pain attack, they cannot have returned to normal within 3 days.
  5. Normal abdominal imaging by CT or MR/MRCP with bile duct reported at ≤9mm.
  6. Upper endoscopy examination without findings to explain the pain.
  7. Pain persisting despite a one trial of acid suppressant medications for one month (if tolerated).
  8. Pain persisting despite a trial of antispasmodics.
  9. Subjects on antidepressants for pain control (not required) should be taking them for a minimum of one month prior to the baseline assessment.

9.Patients with SOD with depressive and/or anxiety disorders who receive psychopharmacologic treatment must be on stable medication dose for at least 6 weeks.

10.Access to a telephone. 11.Must be able to speak, read, and write English. 12.Signed and dated informed consent.

Exclusion Criteria:

  1. Prior ERCP treatment.
  2. Age < 18 or Age > 65.
  3. Pregnancy: Women who are pregnant at the time of Screening* will be excluded from the study. (*Note: Women who become pregnant AFTER the Baseline Visit/ERCP will be allowed to remain in the study for telephone follow-up visits).
  4. Prior gastric resection or surgery involving biliary diversion.
  5. Prior diagnosis of acute pancreatitis (lipase >3 x ULN) including post-ERCP pancreatitis, or of chronic pancreatitis by radiological imaging, EUS 5 or more criteria, or Cambridge criteria moderate or more on ERCP.
  6. Daily use of prescription analgesics over the previous month.
  7. Abdominal discomfort every day for the past month at level of 3 or more on a scale of 1-10.
  8. Presence of significant psychiatric disorders:

    1. Lifetime psychotic disorders, bipolar disorder;
    2. Substance use disorders within 6 months;
    3. Eating disorders within 2 years
    4. Moderate & severe depression defined by BDI-II (Beck Depression Inventory) cutoff scores >22 (unless receiving stable psychiatric therapy for six weeks); and/or,
    5. Suicidal risk (equal to or greater than "low") using MINI suicide section or a score of greater than 0 on question 9 of the BDI.
  9. The total number of days in the previous 3 months that the subject has taken prescription analgesics due to episodes of abdominal pain is greater than the total number of days the subject had episodes of abdominal pain.
  10. Any condition that, in the investigator's opinion, makes the subject unsuitable for study participation.

ERCP Criteria:

  1. Pancreas divisum (complete or partial) (known or discovered at study ERCP).
  2. Any pathology found at ERCP (except sphincter hypertension).
  3. Failed pancreatic manometry.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00688662

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United States, Connecticut
Yale University
New Haven, Connecticut, United States, 06510
United States, Indiana
Indiana University
Indianapolis, Indiana, United States, 46202
United States, Minnesota
University of Minnesota
Minneapolis, Minnesota, United States, 55415
United States, Missouri
Midwest Therapeutic Endoscopy Consultants
Saint Louis, Missouri, United States, 63141
United States, South Carolina
Medical University of South Carolina Digestive Disease Center
Charleston, South Carolina, United States, 29425
United States, Texas
Methodist Dallas Medical Center
Dallas, Texas, United States, 75203
United States, Washington
Virginia Mason Medical Center
Seattle, Washington, United States, 98101
Sponsors and Collaborators
Medical University of South Carolina
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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Principal Investigator: Joseph Romagnuolo, MD Medical Universtiy of South Carolina
Principal Investigator: Martin Freeman, MD University of Minnesota
Principal Investigator: Richard Kozarek, MD Virginia Mason Medical Center
Principal Investigator: Evan Fogel, MD Indiana University
Study Chair: Peter Cotton, MD MUSC Digestive Disease Center
Principal Investigator: Paul Tarnasky, MD Digestive Health Associates of Texas
Principal Investigator: Giuseppe Aliperti, MD Midwest Therapeutic Endoscopy Consultants
Principal Investigator: Priya Jamidar, MD Yale University
Study Director: Jose Serrano National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Publications automatically indexed to this study by Identifier (NCT Number):

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Responsible Party: Peter Cotton, Study Chair, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Identifier: NCT00688662    
Other Study ID Numbers: DK074739
U01DK074739 ( U.S. NIH Grant/Contract )
First Posted: June 3, 2008    Key Record Dates
Results First Posted: July 28, 2016
Last Update Posted: April 19, 2018
Last Verified: March 2018
Keywords provided by Peter Cotton, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):
Sphincter of Oddi Dysfunction
Additional relevant MeSH terms:
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Sphincter of Oddi Dysfunction
Biliary Dyskinesia
Common Bile Duct Diseases
Bile Duct Diseases
Biliary Tract Diseases
Digestive System Diseases